Author + information
- Fred H.M. Wittkampf, PhD∗ (, )
- René van Es, PhD and
- Kars G.E.J. Neven, MD, PhD
- ↵∗Cardiology, University Medical Center Utrecht, E03.406, P.O. Box 85500, Heidelberglaan 100, Utrecht 3508 GA, the Netherlands
We would like to thank Prof. Miklavčič for his comments on our paper (1) and acknowledge his important contributions to the field of electroporation. As physicists and cardiologists, we know that bipolar application via 2 closely spaced electrodes results in a confined electrical field that may eliminate skeletal muscle stimulation. The steep exponential decay in current density away from the electrodes causes rather sharp lesion margins. Consequently, however, lesion depth will be limited. However, with poor tissue contact, as often happens with multielectrode catheter ablation in a moving target such as the heart, lesions may then be minimal or even absent. This is the reason why we have chosen to use a unipolar circular application. The much more gradual decay in current density facilitates deep and broad lesions, perhaps even with poor tissue contact. The gradual decay in combination with small local differences in tissue properties indeed also cause diffuse lesion margins as is shown in our publications. Skeletal muscle stimulation is another disadvantage, but with little clinical relevance given the current practice in many countries to perform catheter ablation for atrial fibrillation under general anesthesia.
Many studies have investigated the thermal effects of electroporation ablation and the general conclusion is that irreversible electroporation can be achieved without causing tissue temperatures over 50°C. In our studies, we searched for macroscopic and histologic markers of thermal damage, but failed to find any. In addition, total applied energy per electrode is comparable to <1 s of radiofrequency ablation. Lethal temperatures are therefore unlikely.
Details about the new energy source have been submitted and current and voltage levels that were applied with a decapolar circular catheter have been published in references 10, 36, and 79 (2–4) of our JACC: Clinical Electrophysiology review paper (1).
We fully agree that there still are numerous questions, including those mentioned by Prof. Miklavčič, that warrant further study and we hope that members of the electroporation community are triggered to do so. As cardiological scientists we felt free to explore this fascinating new ablation technology and we hope that our approach stimulates others to continue preclinical as well as clinical research in this area.
Please note: Dr. Wittkampf is a consultant for Abbott and St. Jude Medical; and is a coinventor of circular electroporation ablation and receives royalties from its commercial use. Dr. van Es is a coinventor of circular electroporation ablation and receives royalties from its commercial use. Dr. Neven is a consultant for Abbott.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- 2018 American College of Cardiology Foundation
- Wittkampf F.H.M.,
- van Es R.,
- Neven K.
- Wittkampf F.H.,
- van Driel V.J.,
- van Wessel H.,
- et al.
- Van Driel V.,
- Neven K.,
- Van Wessel H.,
- Vink A.,
- Doevendans P.A.,
- Wittkampf F.H.